There are many reasons women may delay pregnancy. According to the American College of Obstetricians and Gynecologists, there is an upward trend in the average age of pregnant women worldwide. 

In the United States, about 19% of all pregnancies and 11% of first pregnancies are currently in those over age 35. In 2020, the average age for a first birth was 27.1, compared with 21.4 years in 1970. 

If you are pregnant or planning a pregnancy over age 35, you may have many questions or concerns about pregnancy and childbirth. 

What is advanced maternal age?

Advanced maternal age (formerly called “geriatric pregnancy”) refers to people who will be 35 years or older at their estimated delivery date. Historically, pregnancies at this age have been considered higher risk for both the patient and the baby. 

What are the risks?

While pregnancies at age 35 and older are considered higher risk, not all will face the same challenges. Potential risks are on a spectrum and increase with age. Medical studies divide these age ranges and their associated risks into five-year increments. 

"At Nebraska Medicine, we look at age as only one component," says Neil Hamill, MD, maternal-fetal medicine doctor. "We consider everything that may be going on in your life that could complicate your pregnancy and then make plans based on all the variables." 

Increased risk factors include:

• The development of age-related diseases, such as high blood pressure, obesity or diabetes.
• Changes in egg quality, which can affect fertility and chromosome abnormalities.
• Lower fertility rate.

Potential complications include an increased risk of:

• Gestational diabetes.
• Cesarean delivery.
• Preterm birth.
• Miscarriage and stillbirth.
• Fetal growth.
• Chromosomal abnormalities and congenital malformations.
• Multiple pregnancies (twins).
• Preeclampsia, especially over age 40.

Pregnancy care over 35: What to expect

Your care plan will depend on your age, health history and other factors. Your doctor will consider all risk factors when developing your personalized plan.

Depending on your situation, expect to discuss:

• Ultrasounds: Often used more commonly in women 35 and older, with exams common in the first trimester, at 20 weeks and periodically as pregnancy advances.
• Screening options: Prenatal DNA screening, genetic counseling or diagnostic testing.
• Antenatal fetal surveillance: Tests that assess a patient’s risk for stillbirth.
• Labor and delivery preferences.
• Low-dose aspirin: May recommended if you have two or more risk factors to help reduce the risk of preeclampsia.

"Although there is an increased risk at or over age 35, we still see the majority of women deliver at term with babies that thrive," says Dr. Hamill. "There are more decisions to be made, but typically these women approach with the readiness and education they need to start or expand their family."

Preparing for your pregnancy

If you're planning a pregnancy over age 35, look closely at your current health and any medications you are taking. If you have a chronic health problem, address it with your doctor. Ask them how you could make pregnancy safer and healthier. 

"We support our patients by treating the whole person," adds Dr. Hamill. "We discuss not only all physical aspects but also things like their support system and mental health. We walk them through what to expect at every stage of pregnancy and guide them through it."

Tips to keep in mind:

• Unless you have a chronic illness or a medical condition, you may not need to see a maternal-fetal medicine specialist. It is common to stay with your obstetrician and only consult with a high-risk specialist if complications arise.
• If you're at risk of early delivery, try to get your house ready earlier to feel prepared.
• If complications occur, know that there is nothing you did (or didn't do) that caused them.
• Consider attending one of our childbirth education classes and pregnancy and postpartum support groups.